Harvest

This time of year, it is evident that piles of shit can grow beautiful flowers.

I think that is the best way to look at my experience in ICU. I am finished with orientation at my new job. I feel so much better every day. Going to work is not a chore, I don't get that dreading, sick feeling in my stomach in the morning anymore. I come home at night considerably less exhausted. I recover faster between shifts.

I feel at ease with my new co-workers, I feel welcome. Two weeks into my new job, I received a card in my mailbox from one of my new coworkers, welcoming me. I attended a social gathering at my new manager's house last weekend and it felt so...normal. There was no weirdness, no avoidance, no feeling like I was the outcast and missing the secret that everyone else knew.

During my orientation, I have learned that I'm not a bad nurse, and I do know a few things. It's also interesting that the first thing they said about me was that my time management, organizational and prioritization skills were great. The things I struggled in this new gig were the manual skills like starting IVs, tapping and untapping ports, and doing PICC dressing changes, since we rarely started IVs in ICU, and never tapped ports or changed those dressings. I felt inefficient at these and they were slowing me down.

Three weeks into orientation my preceptor suggested we take two days away from patient care and spend those days with me doing everybody's IV starts, port taps, and PICC dressing changes. They arranged the schedule so I could do that, and it was a great experience. I feel so much more confident on my IV starts and I'm now comfortable doing all of those other things.

Amazing how you can ask for something that you need help with, and you get help. You address it early, and then you move on. How difficult is that? How difficult can it be to help a new person in the unit feel at ease and comfortable? How difficult is it to make eye contact, say hello and acknowledge someone's existence?

The circumstances around my last few shifts in ICU were uneventfully unpleasant, as I should have expected. On my last real shift, no one really talked to me, no one acknowledged that I was leaving except for the day and night charge nurses, in private conversations with me, they wished me well. My coworkers said nothing, and I really didn't feel I owed them anything, so I said nothing.

The Hen was working that day doing patient care, which was a blessing, because with her being in charge it would have likely turned out much worse. I went about my business taking care of my patients. At one point the charge nurse came up to me and told me The Hen had asked her why I was being so standoffish. I didn't think I was being any different, but maybe I was withdrawn into my own world more than usual. I told the charge nurse, "Why don't you say to her, Go ask Jane."

I was so tired of the game. I blew it off and went home that night, trying not to think about it, knowing that in three days I'd be starting my new job, and only had that one on call shift the following week and I'd be permanently released from my sentence.

The next week I got a call mid-week from my old mentor in ICU, telling me that the boss (our director) asked her to call and check with me that I am really on-call that Friday because we were short-staffed, just a charge nurse and two nurses, the unit was busy, and Miss Manager was on vacation. Miss Manager had sent out an e-mail before she left on vacation assuring everyone that we would be well staffed and admonishing everyone not to call in sick.

So I sent my director an e-mail. I told her, yes, I am on-call and I told her I would be there. Just for fun, I decided to tell her the circumstances surrounding my agreement to be on-call that day. And I told her how Miss Manager had treated me regarding the schedule the previous week, and I told her I would have appreciated a little more diplomacy and consideration my last week working in the unit.

A day went by, then I got an e-mail reply. She apologized for the way Miss Manager had treated me. She thanked me for all I had done in ICU, and asked me if she could take me to lunch.

My jaw dropped. At first my instinct was to say no. I didn't want to have lunch with her, I didn't want to sit there and say watered down things and act like, everything is okay, I'm just moving on because of my interest in oncology, no hard feelings, and so on.

I asked someone I knew in Human Resources how I might handle this situation, and he told me to go ahead and be honest. I was out of the unit, I had started my other job, and I might as well let her know. It might not change anything, but it might make me feel better.

Turned out we arranged to meet at a little sandwich shop across the street from the hospital two weeks later.

When I worked my final on-call shift, I had already started in my new unit and I proudly showed off my new employee badge to my few understanding co-workers, with my new department on it. The nurse in charge that day was one of the ones who was leaving in another two weeks. She was kind to me, gave me one patient to transfer out and then I got to go home after working just 4 hours.

It felt strange though. It seemed like anyone else who left the unit in the past got some acknowledgement from the general staff, like a card that people signed, wishing them well. It was like I disappeared, but I had never really been there in the first place. Other than a few people who worked weekends with me, I was still mostly invisible in my departure.

Turned out that my old mentor got an interview in the ICU at the other hospital that was scheduled at the exact same time as my upcoming lunch with the boss. We agreed to call each other afterwards and compare notes.

When I met my boss for lunch, she was already there, at a table outside. After a little chit chat, I didn't waste any time. I said, "I appreciate you taking me to lunch. I have some things to tell you, and it's not going to be pretty, but I need to let you know why I left." She asked what she could do for me. I said, "Just listen to what I have to say."

I started out by telling her that I felt like a leper most of the time I worked there. I felt like I worked in two different units. There was the weekend unit, with a completely different level of professionalism and interaction than the weekday unit. I told her I chose to work weekends because I was treated fairly, I got challenging but fair assignments, and I could rely on my co-workers for help. There was good teamwork, and the charge nurse had a handle on what was going on in the unit, there was always someone manning the front desk, the unit assistant actually did her job and didn't roll her eyes when asked to do something.

And then there was the weekday unit. Where Jane didn't exist. There was a ghost taking care of my patients, I could expect not to be talked to, not acknowledged, not communicated with, given ridiculously busy assignments with no help from the unit assistant or charge nurse, where my call lights would be turned off at the desk and no one would come down and help me.

She had heard all of these things before from me, at different times, some more than once. This was nothing new I was springing on her after the fact. I'd been in her office no less than half a dozen times over the past 3 1/2 years or had pointed these things out at staff meetings, perhaps more diplomatically stated and carefully presented. Now I wasn't holding back.

I told her about the way The Hen had treated me, how she denied everything and tried to change the subject when I talked to her about it, even after dragging her in front of the boss and confronting her on how she acted toward me, it had only gotten worse. I told her about the other charge nurse who made up the little "thank you" cards for every single person in the unit except me and posted them on the board in the report room.

My boss had a defense for every single one of the things I said. Throughout the whole sitting, I felt like I was quizzing her in a flash card review of Management for Dummies. Everything felt like a premeditated response from a leadership seminar.

When I stopped, she asked me, "If you could give me three pieces of advice, what would they be?" This must be the bonus question on Management for Dummies.

I took a deep breath. She asked for it. But again, she had a defense or excuse prepared. She had been up late, cramming.

1. Consider switching out your leadership team. Not only do they not have the skills to be leaders, they don't even have the basic personality traits they need, like empathy.

Her reply: "Like what skills?"

2. Saying you're doing something does not mean you're actually doing it. Like having a healthy work environment. That is not a healthy environment, when someone feels like this.

Her reply: "One thing I don't operate on is dishonesty." She looked me in the eye for a fleeting moment and looked away. Then she whipped her head back around, looked at me again and said, "I don't."

Apparently she needed to say it again so she could believe it. Was she losing at her own game?

3. There are too many secrets, too much favoritism, too much reliance on maintaining the clique, rather than attention to good patient care and professionalism. Select people are given opportunities that are not offered to everyone. I reminded her that I had asked once, in a staff meeting, "What do you all do in your leadership meetings? You spend how many hours a month in those meetings, like 8 or 12 hours. How does it benefit the unit?" and that Miss Manager had promised to keep us informed and put out a synopsis of what leadership was doing. It happened once, and never again.

Her reply: "That would be like me going to senior management and insisting they tell me what's going on in their meeting."

There's a difference though. Senior management is not one third of the entire hospital workforce. Her little leadership team consists of 10 nurses in what is now a 32 person unit. That's a lot of people with privileged information.

When it was all over, we said good-bye, I thanked her for lunch and for listening to me. And we went on our separate ways. I saw her pull out her omnipresent Blackberry. She was probably texting The Hen.

When I got home from the leadership seminar pop quiz session, I checked my e-mail. There was a message from my old mentor. "I got the job!" I called her, and she told me about how they offered her the job after a brief interview. We decided to go out and get a drink and celebrate. I told her about my lunch with the boss. We began to strategize about how she would give notice, and when we would have a survivors' party to celebrate among most of the now seven of us who were leaving the unit or had recently left.

In the six weeks since I started my new job, I have not run into a single person from ICU whom I would not want to talk to. The only people I have come across are the ones I liked. I find that interesting. It's almost like I've been protected while I'm doing the most healing, until I'm ready to face an encounter with any of them. Maybe it's because what would come out of my mouth at this point would be less than kind, less than appropriate, less than professional.

I suppose when it happens, I'll be ready. I needed to get to the point where my anger didn't exceed my ability to deal with those people as individuals in a dysfunctional system. I think with each passing day I am moving closer to healing. Occasionally something takes me by surprise, it feels like a setback at first, but then I move through it.

My third week of orientation, the week after I had lunch with my old boss, I walked into work Monday morning and found a package in my mailbox. I wondered who could be sending me a package. I looked at the front of the interdepartmental mail envelope and saw it was from Miss Manager in ICU. I got a sick feeling in my stomach as I opened it partially to see what was in it. It was bubble wrapped, but I knew what it was. She had sent me the plaque off the wall from outside the unit. Each of the staff in ICU had a picture plaque up there, our faces, with captions underneath us giving our names and credentials.

I bet she couldn't wait to take that thing off the wall and send it to me.

It felt like a kick in the stomach. All of the rejection and nasty feelings came flooding back and I started crying. I needed to get my emotions in check so I could go about my work day, but I was distracted and upset and periodically had to make a trip to the bathroom just to cry and put cold water on my face. I am sure people noticed. It was hell getting through the day.

My preceptor and I talked at one point midway through the day, she said she sensed things weren't going very well that day, and as soon as she said it I burst into tears. I told her I was upset about something that happened first thing that morning and I felt like I just needed to get back to work and get my mind off of things. So we took an easier assignment the rest of the day and I got through it. I debated whether to tell her, and I really didn't want to.

At the end of the day we were leaving together and we walked into the breakroom to get our stuff, and I burst into tears again despite trying to hold it all back. I felt like such an idiot. I felt so embarrassed that all this stuff had affected me so much that it was interfering with my work day at my new job. That really pissed me off, I wanted to leave it all behind. But I took the package out of my box and showed my preceptor. "This is what got me off to a bad start today."

She looked at it and nodded. She said, "I heard that things aren't good up there, and I know there's a lot of turnover. I'm sure this really hurts."

We walked out toward the parking garage together. One of my old coworkers, one of the younger and more outspoken nurses from ICU was walking toward us on her way in for her night shift. She is leaving the unit for a job in the OR. She saw me and announced loudly, "Seven more shifts, baby!" When she got up to us, she gave me a hug, she saw my eyes, and I told her, "I got my face in the mail today." I felt the tears starting again. I showed her the plaque.

She said, "Oh my God, I am so sorry." She hugged me again and looked at my preceptor, who was standing there. "It sucks. It is hell. Seven more shifts and I'm outta there too."

I introduced her to my preceptor. After she went on toward the building, I apologized. She looked at me and said, "I think I understand. Word gets around." She wished me a good night and said, "It will get better with time. See you tomorrow."

After that event, I realized I am not ready to go off antidepressants yet and I am still meeting with the counselor from EAP when I feel the need. With my annual evaluation coming up in October, where I will have considerable input from my old boss, since I was there most of the year, I am wary. But I also know that my new boss will give me real input and she'll be able to see how I really am from the job I do. And I am sure she's heard things about ICU too.

In general, around the hospital people have told me how happy I look, when they see me in my new department their first reaction is usually, "What are you doing here?" and when I tell them, they usually seem surprised that I left ICU or else they give me this knowing look or say, "There's been a lot of turnover up there. What's going on?" and of course I have to shrug my shoulders. My PC answer is, "I have been interested in oncology for a long time and the opportunity came up, and I decided to make the move." Which is true, so it's easy to say it. But a lot of people know there is something beyond that, because word gets around, and there are half a dozen others like me around the hospital who have left ICU.

Some of the things I've now realized are that I understand why I enjoyed having the other staff around. I felt closer to most of the respiratory therapists, nutrition people, discharge planners, social workers and physical therapists I worked with than many of my co-workers in my own department. They talked to me. They interacted with me as a human being. We did our work, but they also knew me as an individual and we got to know each other as people.

I ran into another former co-worker last week while I was at the other hospital. She told me when she left, she was exhausted from all the bullshit and game playing. She feels so much better now but she felt it took her a while to recover from that, she was tired for a long time and now she looks back and realized where all the fatigue came from.

That unit operates like a dysfunctional family. Anyone who tries to change things, or threatens to leave and expose the secrets will be punished or cast out. Like rodents, they run back into their holes, circle the wagons, and try to justify everything they do with their management seminar canned defenses.

The thing that inhibits healing from these situations is that we get it drilled into our heads that we need to "forgive and forget". Forgiveness does not mean that we should ignore what happened to us. Invalidating the real, hurtful feelings that we endured and the inhumane, nasty treatment we received impairs the healing process.

It's important to name it. There are names. Mobbing. Eating their young. Horizontal hostility. Vertical hostility. Workplace abuse.

Whatever you call it, it has no place in a healthy work environment, or anywhere. But since there is so much fear and risk in the workplace, it is up to the individual who has been affected by it to decide what they need to do in order to move forward. Usually it means leaving. Unfortunately the bad people stay behind and find new targets. Who knows how long it will take until my old boss is gone. The organization never calculates the hidden costs to people's health and well-being.

I am still in the process of healing. I'm not going to pretend it never happened and I'm not going to minimize it. It's a dysfunctional system. If I can do anything to take steps to fix it, I will. I might not have much power in the organization, but I can do it in small ways, with individuals, by listening to them, and speaking when it's necessary, if it can make a difference for someone.

This concludes my nursing school journal blog.

Peace, love, and fertilizer,

Jane Smith, RN